OCI Links High Risk Claims to Duplicate Payments
09/04/2009
OCI ANALYTIC LINKS HIGH-RISK CLAIMS IN 40% OF DUPLICATE BILLED WORKERS' COMP CLAIMS
 

Denver, Colorado – OCI recently conducted a follow up study on their duplicate workers’ comp and healthcare payments analysis and found that 40% of duplicated payments were associated with high-risk claims. By delving deep into risk score* analysis and ICD-9 distribution, OCI was able to uncover a number of interesting patterns in duplicate payments:

  • 40% of duplicated payments were associated with high-risk claims while only 28% of non-duplicated payments were associated with high risk-claims
  • 8% of the provider group filed duplicate bills for multiple patients (duplicate billers)
  • 10% of the duplicated billers filed duplicate payments for the claim repeater cohort
  • 6.5% of the employer’s employee population had duplicate payments for multiple claims (claim repeaters)
  • 23% of the claim repeaters went to providers in the duplicate billers group
  • 62% of duplicate biller and claim repeater intersected cohorts were high-risk claims
  • Distributions were very similar with the exception that physical therapy coded claims prevalence in the duplicate payment group was double that of the non-duplicate payment group
Identifying these patterns allows organizations to better target potential duplicate payments and recover overpayments sooner. To prevent duplicate claims, an employer or organization must commit to integrating its workers’ comp, healthcare billing and claims data to identify where the duplicate billing and payments occur.
 
OCI’s Information Management Solutions provides the data integration necessary to complete this analytic study for any organization or company. In addition, OCI also provides ongoing tracking and detection capability, which allows employers to stop duplicate payments before they are paid or recover overpayments sooner. To recover payments, OCI will send claim information (scrubbed of PHI) that identifies duplicate payments to the existing recovery vendor or recovery system.
 
For more information on OCI’s Workers’ Comp & Healthcare Duplicate Payments Analysis and ongoing study please email solutions@oci.com or please visit www.oci.com.
 
*Scores based on the OCI claim complexity scoring methodology.
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About OCI - OCI is an information management solutions provider that helps companies make better-informed decisions about their risk management and employee benefit programs. 
 
OCI has designed and delivered integrated health and productivity solutions to Fortune 1000 companies since 1984. Using secure web-based applications, a flexible, client-centric approach and deep industry experience, our solutions transform data into information and knowledge, giving our customers the power to increase administrative efficiency, reduce expenditures and improve productivity.  www.oci.com